1720062219 NPI number — MS. BERNICE ANN ETTORE RN

Table of content: MS. BERNICE ANN ETTORE RN (NPI 1720062219)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720062219 NPI number — MS. BERNICE ANN ETTORE RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ETTORE
Provider First Name:
BERNICE
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CASTELLUCCI
Provider Other First Name:
BERNICE
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1720062219
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
UNIT 45011 BLDG 704 ATTN MCJA QM
Provider Second Line Business Mailing Address:
USA MEDICAL DEPARTMENT ACTIVITY JAPAN
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AP
Provider Business Mailing Address Postal Code:
96338-5011
Provider Business Mailing Address Country Code:
JP
Provider Business Mailing Address Telephone Number:
011813117638206
Provider Business Mailing Address Fax Number:
011813117638183

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
UNIT 45011 BLDG 704 ATTN MCJA QM
Provider Second Line Business Practice Location Address:
USA MEDICAL DEPARTMENT ACTIVITY JAPAN
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AP
Provider Business Practice Location Address Postal Code:
96338-5011
Provider Business Practice Location Address Country Code:
JP
Provider Business Practice Location Address Telephone Number:
011813117638206
Provider Business Practice Location Address Fax Number:
011813117638183
Provider Enumeration Date:
11/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WX0106X , with the licence number:  205258 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 163WX0106X , with the licence number: RN098020 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com